Provider First Line Business Practice Location Address:
12640 SABRE SPRINGS PKWY
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-486-9096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2005